Document 5bnE1pv5j4kQo9gz0MDVjXyN0

SHANGHAI HEALTH STUDY ANNUAL MEETING 1 - 3 NOVEMBER 2005 RESERVATION I REGISTRATION REQUEST Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ First Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Last Name: Name for Badge: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ Company or Affiliation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Address: Phone: _ _ _ _ _ _ _ _ _ _ _ Fax: Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ACCOMMODATIONS: __ (I I We) plan to stay at the Ritz-Carlton in Tyson's Corner, Virginia. Important: Participants are responsible for contacting the hotel directly to reserve a room. Please inform the hotel that you are with the Shanghai Health Study. Hotel Information: Phone: (703) 506-4300 Website: Ritz Cariton Tyson's Corner Reservations I will arrive on: _ _ _ _ _ _ __ Departon: _ _ _ _ _ _ _ _ _ _ _ _ _ __ ADDITIONAL GUESTS: First and Last Name(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ SPECIAL EVENTS: (Yes I No) (I I We) will attend the reception and dinner at Maggiano's on Tuesday evening, Nov. 1st): (# of adults __ # of children_ _) (Yes I No) (I I We) will attend the dinner at Peking Gourmet Inn on Wednesday evening, Nov. 2nd : (# of adults __ # of children_ _) I (have I do not have) special needs. Please let us know how we can assist. Please email completed registration form to toddm@api.org or fax to Matt Todd at 202-682-8031 SHELL-MCCLURG-057819